Factors Influencing Treatment Outcomes among Chronic Hepatitis B Patients Attending the Korle-Bu Teaching Hospital.

Abstract

Background: Hepatitis B is a major public health challenge and WHO is making all efforts at eliminating it as a public health threat by 2030. Elimination includes reduction of the reservoir of transmission through antiviral therapy. Sub-Saharan Africa is one of the regions of the world with high burden of disease. Treatment with antiviral therapy is almost unavailable and/or inaccessible. The study seeks to find factors affecting response to antiviral therapy in chronic hepatitis B (CHB) patients attending the Korle Bu Teaching hospital. Aim The aim of the study is to elucidate the factors that impact on treatment outcomes of chronic hepatitis B patients attending the Korle-Bu Teaching Hospital. Methods: A retrospective medical chart review was done using total enumeration sampling method from 2013 to 2018 in a teaching hospital in Accra. Data on CHB was abstracted based on eligibility criteria. Baseline parameters included sociodemographic, viral markers, liver biochemical test and pretreatment liver disease. A student t-test was used to determine changes in their pretreatment parameters. Binary logistic regression model was used to determine the effect of the independent variables on treatment outcome. Statistical analysis was performed using STATA version 15 at 95% confidence level. Results: Seven hundred and eight patients’ folders were reviewed. Average age of patients was 37.98 ± 10.52 years and averagely 33.08 ± 10.40 years at the time of diagnosis. Males were relatively more than females (65.82%, 466/708). Over 50% (59.01%, 416/705) of the patients were married. Almost half of the participants had normal BMI (46.6%, 330/708). Three percent were co-infected with HCV (18/589) and 4% had diabetes (4.23%, 29/685). Fatty liver was present among 2.1% of the 677 patients with records. 5.4% of the 681 patients with records had preexisting liver disease. One-fifth of the patients were alcohol users (19.94%, 138/692). Of these, two-thirds of them drink >14 units/week (67.39%, 993/138). Less than a third of the patients were on treatment 30.5% (216/708) with over half having had treatment interruptions (52.8%, 114/216). One-fifth of the patients were HBeAg-positive (146/692) and 67.6% had undetectable HBV DNA (146/216). ALT and AST normalization occurred in over 50% ALT (55.8%, 87/156) and AST (53.5%, 157). HBeAg seroconversion was attained by 13.8% of 85 patients with such records. From the multiple logistic regression model, advancement in age at diagnosis, (AOR: 0.77, 95% CI: 0.61-0.97), male patients, (AOR: 0.30, 95% CI: 0.11-0.79), normal BMI, (AOR: 5.94, 95% CI: 1.91 - 18.48) significantly predicted viral suppression. Conclusion The proportion of patients on antiviral therapy was low among chronic hepatitis B patients at Korle Bu Teaching Hospital. Overall, younger age group, females, normal BMI were predictive of good viral and biochemical outcomes. None of the patients lost the HBsAg in this study.